The Association of Urbanicity with Cognitive Development at Five Years of Age in Preterm Children

Abstract

Objective: To determine the association of urbanicity, defined as living in an urban area, with cognitive development at five years of age in preterm children who were free of any disabilities or neurodevelopmental delays.

Design: Prospective population-based cohort.

Setting: French regional Loire Infant Follow-up Team (LIFT) network.

Participants: Included in the study were 1738 surviving infants born between March 2003 and December 2008 before 35 weeks of gestational age. At two years of age, the children were free of any disabilities and neurodevelopmental delays and were living in the Pays de la Loire region from their birth to five years of age.

Main outcome measures: The cognitive development at five years of age was evaluated with the Global School Adaptation score (GSA). The urbanicity of the residence for each child was classified into three groups: urban, quasi-rural, and rural area.

Results: Quantile regression approaches were used to identify a significant association between urbanicity and the GSA score at five years of age (adjusting for child and family characteristics). We found that the negative impact of urbanicity on the GSA score was more important for the lower quantile of the GSA scores.

Conclusions: Urbanicity was significantly associated with cognitive neurodevelopment at five years of age in preterm children born before 35 weeks of gestation. Complementary results additionally suggest that this relation could be mediated at the residence level by a high socioeconomic deprivation level. If these results are confirmed, more personalized follow-ups could be developed for preterm children. Further studies are needed to finely identify the contextual characteristics of urbanicity that underlie this association.

Fig 1. Flow chart.

Fig 2

A) Localization of the PDL region in France B) Urbanicity and major cities in the PDL region.

Fig 3. Association between the urbanicity of the residence and the GSA score at age five using model 3.

The x-axis represents the quantile level (e.g., 0.2 = 20^th percentile) of the GSA score and the y-axis represents the corresponding estimated impact of the level of urbanicity on the GSA score compared to the residence (Panel A: quasi-rural residence, Panel B: urban residence). Panels A-B show the results from a mixed quantile model adjusted for child and parent/family characteristics (model 3). The dotted lines represent pointwise 95 percent confidence intervals.